| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| STEALTH PARTNER GROUP LLC3 Filed as: STEALTH PARTNER GROUP | 18700 N HAYDEN RD STE 405 SCOTTSDALE, AZ 85255 | SYMETRA LIFE INSURANCE COMPANY | $10K | — | $10K | 7.36% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 15.00% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | WYSSTA INSURANCE COMPANY INC | $1K | — | $1K | 7.94% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $3K | — | $3K | 15.00% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $494 | — | $494 | 15.01% |
| MCCLONE AGENCY INC3 | PO BOX 389 MENASHA, WI 54952 | LIFE INSURANCE COMPANY OF NORTH AMERICA | $118 | — | $118 | 14.94% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| BLUE CROSS & BLUE SHIELD EIN 39-0138065 CLAIMS PROCESSING | Recordkeeping and information management (computing, tabulating, data processing, etc.); Contract Administrator; Other services; Float revenue; Claims processing Service code 12 | — | $12K |
| DELTA DENTAL OF WISCONSIN EIN 39-6094742 THIRD PARTY ADMIN | Contract Administrator Service code 13 | — | $3K |
| MCCLONE INS AGENT OR BROKER | Insurance agents and brokers Service code 22 | PO BOX 389 MENASHA, WI 54952 | $2K |
| COMPCARE HEALTH SERVICES INSURANCE EIN 39-1462554 CLAIMS PROCESSING | Contract Administrator; Recordkeeping and information management (computing, tabulating, data processing, etc.); Claims processing; Float revenue Service code 12 | — | $0 |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 344 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 344 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Vision | WYSSTA INSURANCE COMPANY INC | 134 | $18K |
| Life insurance | LIFE INSURANCE COMPANY OF NORTH AMERICA | 344 | $3K |
| Short-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 344 | $21K |
| Long-term disability | LIFE INSURANCE COMPANY OF NORTH AMERICA | 344 | $17K |
| Stop-loss / reinsurancereinsurance(2 contracts, 2 carriers) | SYMETRA LIFE INSURANCE COMPANY | 203 | $137K |
| Other(2 contracts) | LIFE INSURANCE COMPANY OF NORTH AMERICA | 344 | $4K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 344 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
The primary carrier changed from prior filing. The plan is already willing to move; opportunity to re-pitch on the next cycle.
Primary broker changed. Recently changed advisors; vulnerable to a second-look pitch or hostile takeover.
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.